Abstract
BackgroundEven though the incidence of community-acquired Clostridium difficile infection (CDI) is reported to be increasing, few studies have reported on the healthcare costs of community-acquired CDI. We estimated cost of care for individuals with community-associated CDI and compared with that for matched controls without CDI in the time period of six months before to one year after CDI.MethodsAll individuals in the province of Manitoba, diagnosed with CDI between July 2005 and March 2015 were matched up to 4 individuals without CDI. Health care utilization and direct costs resulting from hospitalizations, physician reimbursement claims and prescriptions were determined from the population based provincial databases. Quantile regressions were performed to determine predictors of cost of individuals with community associated CDI.ResultsOf all CDIs, 30–40% in each period of the study had community-associated CDI; of which 12% were recurrent CDIs. The incremental median and 90th percentile cost of care for individuals with community-associated CDI was $800 and $16,000 respectively in the six months after CDI diagnosis. After adjustment for age, co-morbidities, sex, socioeconomic status and magnitude of health care utilization prior to CDI, the median incremental cost for recurrent CDI was $1,812 and that for a subsequent episode of CDI was $3,139 compared to those with a single community-associated CDI episode. The median cost for a prescription of Vancomycin was $316 (IQR 209–489).ConclusionsHealth care costs of an episode of community-associated CDI have been much more than the cost of antibiotic treatment. Our study provides population-based data for formal cost effectiveness analysis for use of newer treatments for community-associated CDI.
Highlights
Clostridium difficile (CD) is a Gram-positive anaerobic spore forming bacterium that produces toxins and can lead to clinically significant diarrhea and substantial morbidity and mortality [1]
The median cost for a prescription of Vancomycin was $316 (IQR 209–489)
Health care costs of an episode of community-associated Clostridium difficile infection (CDI) have been much more than the cost of antibiotic treatment
Summary
Clostridium difficile (CD) is a Gram-positive anaerobic spore forming bacterium that produces toxins and can lead to clinically significant diarrhea and substantial morbidity and mortality [1]. The increasing incidence and associated morbidity and mortality have created an impetus to develop newer therapeutic approaches[1, 5]. While these newer agents are more expensive than traditional antibiotics, downstream health care savings could be substantive if the improved effectiveness of these regimens leads to rapid cure and/or a lower incidence of recurrent CDI and less associated morbidity. Up to 40% of CDI have been reported to be community-associated[6], few studies have evaluated health care costs associated with community-associated CDI (caCDI)[7]. Even though the incidence of community-acquired Clostridium difficile infection (CDI) is reported to be increasing, few studies have reported on the healthcare costs of communityacquired CDI.
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